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Diarrhea and dysentery originating from the Zang-Fu organs present with diverse symptoms. Generally, they arise due to dysfunction of the Spleen and Stomach. Mr. Li Dongyuan wrote a treatise titled *Pi Wei Lun* (Treatise on the Spleen and Stomach), which focuses primarily on using Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to raise and lift clear Yang Qi. Regarding the treatment of Pi Xie (Spleen Deficiency Diarrhea), his methods were comprehensive. However, he did not address Shen Xie (Kidney Deficiency Diarrhea). Therefore, for cases caused by Dampness, water-draining methods are used to separate and eliminate it; for those caused by Wind, wind-dispelling methods are used to calm it; for Excess patterns, purgative methods are applied; for Deficiency patterns, tonifying methods are employed; Cold patterns are treated with warming methods, and Heat patterns with clearing methods. Food stagnation is resolved by digestion-promoting agents, and accumulations are removed. Whether dealing with the mutual overcoming of the Five Elements or the superimposition of the Six Qi, all are treated according to the laws of generation and restriction. So why do some patients fail to see results after months or years of treatment? Zhang Zhongjing stated: "For persistent diarrhea, if the physician administers Li Zhong Tang (Regulate the Middle Decoction) and the diarrhea worsens, it is because Li Zhong Tang regulates the Middle Jiao, whereas this diarrhea originates in the Lower Jiao. It should be cured by applying rules for regulating the Lower Jiao."

Previously, Zhao Yi-de quoted his master saying: "I have heard my master say that diarrhea and loose stools come in many varieties. Besides injuries from the Six Exuberances, Five Evils, and diet, there are often mixed pathogens, making it difficult to adhere to fixed treatment principles." Yet, he observed his master treating a case of sudden Qi collapse leading to severe deficiency, where the patient suffered acute profuse diarrhea, lost consciousness, had closed eyes and mouth, and breathing was extremely faint, nearly ceasing. The master urgently moxaed Qihai (CV6) and administered over ten jin of Ren Shen Gao (Ginseng Paste), resulting in a cure. He also treated a case where phlegm accumulation in the Lungs caused the associated Large Intestine Qi to lose its securing power. By inducing vomiting to expel upper Jiao phlegm, Lung Qi descended, and the deficiency of the Large Intestine naturally recovered. In another case of excessive worry causing Spleen Qi to knot and fail to ascend, sinking into the Lower Jiao to cause diarrhea, he resolved the depression and tonified the Spleen and Stomach to allow Grain Qi to rise. For cases of Yin deficiency where the Kidney could not exercise its controlling authority, he vigorously tonified the Kidney to achieve a cure. There are many such examples. When asked why his treatments were so miraculous, he replied: "There is no secret. It is merely flexible application of principles. Once one has thoroughly mastered the *Nei Jing* (Inner Canon), understanding comes naturally."

The *Nei Jing* states: "The Kidney governs urination and defecation." It also says: "The Kidney controls opening and closing," and "The Kidney opens into the two yin orifices" (anus and urethra). Thus, the Kidney not only governs urination but also controls the opening and closing of defecation. If the Kidney is deficient and weak, the Fire of Ming Men (Gate of Life) extinguishes. With the fire extinguished, Water dominates alone, causing persistent watery diarrhea. This type of diarrhea typically occurs around dawn (Wu Geng time), involving several episodes of projectile stool. Why is this? The Kidney belongs to Water, its direction is North, and its corresponding earthly branches are Hai and Zi. Dawn corresponds to the peak of Hai-Zi Water energy, hence the exacerbation at this time. Only Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) can tonify True Yin, allowing Water and Fire to interact harmoniously within the Kidney, thereby restoring proper opening and closing functions. Moreover, when Ming Men Fire is robust, it generates Earth (Spleen), strengthening the Spleen. Thus, ancient formulas like Jiao Fu Wan (Pepper and Aconite Pill) and Wu Wei Zi San (Schisandra Powder) are divine prescriptions for treating Kidney Deficiency Diarrhea and must be studied.

Reviewing Xue Ji's medical records: For Spleen-Stomach deficiency-cold with sinking Qi, use Bu Zhong Yi Qi Tang added with Mu Xiang (Aucklandiae Radix), Rou Dou Kou (Arecae Semen), and Gu Po Zhi (Psoraleae Fructus). For Spleen Qi deficiency-cold with insecure retention, use Liu Jun Zi Tang (Six-Gentleman Decoction) added with Pao Jiang (Prepared Ginger) and Rou Gui (Cinnamon Bark). For Ming Men Fire decline with Spleen-Earth deficiency-cold, use Ba Wei Wan. For combined Spleen-Stomach Qi and Blood deficiency, use Shi Quan Da Bu Tang (Ten Great Tonics Decoction) taken with Si Shen Wan (Four Spirits Pill). For slippery stools with obstructed urine, or gradual limb swelling, wheezing, coughing, and expectoration indicating Spleen-Kidney damage, use Jin Gui Jian Di Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet).

Qin Yue-ren (Bian Que) in *Nan Jing* (Classic of Difficult Issues) classifies diarrhea into five types: Wei Xie (Stomach Diarrhea), Pi Xie (Spleen Diarrhea), Da Chang Xie (Large Intestine Diarrhea), Xiao Chang Xie (Small Intestine Diarrhea), and Da Jia Xie (Great Mass Diarrhea). Da Jia Xie refers to Shen Xie (Kidney Diarrhea). Annotations state: "It involves tenesmus, frequent trips to the toilet without successful defecation, and pain in the penis." People unaware of this condition mistakenly treat it as Li Xia (Dysentery), bringing immediate disaster. (Li Xia is modern Dysentery.) This is a Kidney Deficiency pattern: the urge to defecate is present but nothing passes, resembling dysentery but not being dysentery, resembling empty straining but not being true empty straining. Tenesmus in dysentery is caused by pathogenic pressure pushing the Large Intestine downward, preventing its ascent and causing heaviness. Treatment uses Da Huang (Rhei Radix et Rhizoma) and Bing Lang (Arecae Semen) to purge the compressing pathogen. Conversely, chronic diarrhea causing Large Intestine laxity and Yuan Qi sinking leads to inability to retract, causing heaviness; here, Yu Ke (Papaveris Pericarpium) and other astringents are used to secure leakage and lift sinking Qi. "Empty straining" (Xu Zuo Nu Ze) occurs after dysentery residue is cleared; the patient strains without stool due to severe blood loss. Treatment doubles Dang Gui (Angelicae Sinensis Radix) and Chuan Xiong (Chuanxiong Rhizoma) to harmonize.

Only Kidney Deficiency tenesmus presents with frequent toilet visits without stool, accompanied by penile pain, or inability to pass stool while urine comes first and is astringent, or the desire to urinate triggers painful defecation urges. Chu Cheng in *Jing Xie Lun* (Treatise on Essence and Blood) notes: "If essence is depleted and further exhausted, the pathways of urination and defecation will pull and hurt; the more it hurts, the more one wants to defecate; the more one defecates, the more it hurts." This requires Bu Zhong Yi Qi Tang with doubled Sheng Ma (Cimicifugae Rhizoma) sent down with Si Shen Wan, or Ba Wei Di Huang Wan ingredients added with Wu Wei Zi (Schisandrae Fructus), Wu Zhu Yu (Evodiae Fructus), Gu Po Zhi, and Rou Dou Kou. Long-term administration yields effects. Many die from limb swelling caused by damaging Yuan Qi with inappropriate dysentery medicines. Since the Kidney governs urination/defecation and opening/closing, incontinence is blamed on the Kidney. By analogy, constipation is also related to the Kidney. *Jin Gui Zhen Yan Lun* states: "North corresponds to Black, connects internally to the Kidney, and opens into the two yin orifices." Thus, Kidney Qi deficiency causes difficulty in both urination and defecation. Suitable herbs include Di Huang (Rehmanniae Radix), Rong Rong (Cistanches Herba), Che Qian Zi (Plantaginis Semen), and Fu Ling (Poria), to tonify Yin and promote water passages, with a little acrid medicine to open pores and distribute fluids to moisten dryness.

Zhang Jiegu said: "Constipation of Zang-Fu cannot be treated uniformly. There is Heat Constipation, Cold Constipation, Excess Constipation, Deficiency Constipation, Wind Constipation, and Qi Constipation. Elderly, postpartum women, those who sweated or diuresed excessively, and those recovering from illness with unrecovered Qi/Blood can all develop constipation. Drugs like Xiao Shi (Natrii Sulfas), Da Huang, Ba Dou, and Qiu Niu are strictly forbidden." People know Heat Constipation but ignore Cold Constipation. Cold Constipation arises from cold qi stagnating in the intestines/stomach, condensing Yin, blocking fluids, and closing Stomach Qi. Patients feel gas attacking inside the intestines, prefer heat, and dislike cold. Treatment uses Ba Wei Di Huang Wan decocted heavily, served cold. Or Ju Fang Ban Shou Wan (Half-Sulfur Pill), crushed fresh ginger, and Ru Xiang (Olibanum) taken together. Or Hai Zang Ji Han Wan are also effective. Hai Zang said: "Although Ji Han Wan is hot, paired with moisturizing agents like Shao Yao (Paeoniae Radix) and Hui Xiang (Foeniculi Fructus), it guides downward. Yin transforms upon receiving Yang, so urination/defecation flow freely. Like spring sun melting snow. Yet, Ba Wei Wan is superior."

Li Dongyuan said: "The Kidney governs the Five Fluids. Abundant fluids mean normal stool. Hunger/fullness irregularities, labor fatigue damaging Stomach Qi, or consuming spicy/hot rich foods aiding Fire evil, which hides in blood and consumes True Yin, leads to fluid scarcity and Large Intestine dryness/constipation. Also, elderly Qi deficiency and declining fluids cause constipation. 'The Kidney dislikes dryness; quickly eat acrid substances to moisten it.'" I adopted Dongyuan's theory but not his formulas, avoiding Run Chang Wan, Run Zao Tang, Tong You San. Instead, I use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) decocted and taken orally for self-healing. For Heat Constipation with Qi deficiency, adding Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) each 5 qian cures it immediately. This is because Qi deficiency fails to push, and Yin deficiency fails to moisten. I have personally tested these methods with certainty, avoiding prohibited Qi/Blood-breaking drugs like Da Huang, Tao Ren, and Zhi Ke. They can be taken long-term without constipation recurrence. Hence, I publish them.

Someone asked: "Why not use Si Wu Tang?" I replied: "Si Wu Tang only tonifies Blood. Here, the issue is insufficient Tian Jin Ye (Heavenly Fluids), causing hard stool. The *Nei Jing* says: 'Large Intestine governs Jin, Small Intestine governs Ye.' And 'Kidney governs Five Fluids.' All fluids derive from Kidney Water, having nothing to do with Blood. Hence, Si Wu Tang is not used." Another asked: "If dryness is extreme, can Xiao Shi and Da Huang be used temporarily?" I replied: "Cheng Qi Tang uses Xiao Shi and Da Huang to treat Tai Yang disease entering interior, transforming from Cold to Heat, invading Three Yin, fearing Kidney water exhaustion. Thus, they purge external pathogens to save Kidney Water. I forbid their use for elderly, deficient, or post-illness patients whose Kidney Water is originally insufficient, causing dryness. Using purgatives here makes deficiency worse. Today brings temporary relief, tomorrow brings worse blockage. Further purging makes even iron-stone impassable. Advise patients not to be impatient to avoid danger. Firm bowel control in elders indicates longevity. Regular use of Liu Wei Wan and Ba Wei Wan ensures health."